Transhiatal Esophagectomy in Cardia and Esophageal Cancer

Jung, Kyoung Won; Choi, Dong Hui; Kim, Dong Heon

Abstract

PURPOSE
The debate is still on-going as to whether a transthoracic esophagectomy (TTE) or a transhiatal esophagectomy (THE) is the proper treatment for patients with cardia and esophageal cancers. This study tries to demonstrate and assess the efficacy and the validity of both surgeries.
MATERIALS AND METHODS
In a retrospective study, data from 52 cases of patients with esophageal and/or cardia cancer who received a surgical operation during the last decade were analyzed.
RESULTS
A TTE was done in 20 cases and a THE in 32 cases. The average times for the operations were 558.0 min for a TTE and 451.7 min for a THE (P>0.05). The estimated blood loss was 1,825.0 ml in a TTE and 1459.4 ml in a THE (P>0.05). The amounts of transfusion during the operations were 3.9 units in a TTE and 2.6 units in a THE (P<0.05). Post-operative complications occurred in 15 cases of TTE and 23 cases of THE. The average length of stay in the hospital was 25.6 days for a TTE and 20.6 days for a THE. The 5-year survival rate was 10% for TTE patients and 28% for THE patients (P>0.05).
CONCLUSION
For most factors, including morbidity and mortality, there was no statistically significant difference between a TTE and a THE. However, a THE is expected to be more convenient, leading to a shorter operative duration, a shorter post-operative hospitalization and lesser amounts of hemorrhage and transfusion. Hence, the THE may be a more valid or efficient surgical method for those patients with cardia and esophagus cancer who require a resection of the esophagus.